[The surgery of pharyngoesophageal carcinoma with vascular anastomosis].
Reestablishment of gastrointestinal continuity following resection of pharyngoesophageal carcinoma can be a challenging problem. Recent developments in vascular surgery have made microvascular anastomosis possible and practical. At present free intestinal interposition grafts and revascularization of the proximal end of pedicle grafts offer the surgeon new options. From 1983 through 1989, reconstruction with vascular anastomosis was performed in 18 cases with pharyngoesophageal carcinoma. Patients were 47 to 88 years old, mean 62.1 years. Reconstructive methods included; free jejunal graft in 14, revascularization of proximal end of a pedicled gastric tube in 1, revascularization of proximal end of a pedicled jejunum in 1, interposition of free jejunal graft between a pedicled gastric tube and the pharynx in 1 and interposition of free ileal graft between a pedicled jejunum and the cervical esophagus in 1 case. Modified radical neck dissection was performed in all cases and superior mediastinal lymph node dissection with median sternotomy was added in 5. The internal jugular vein and common carotid artery were the donor vessels of choice, but in the case of severe sclerosis of the carotid artery, another cervical artery was chosen. The vascular anastomosis was performed using interrupted 7-0 Prolene sutures in the anterior wall and running 7-0 Prolene sutures in the posterior wall under 2.25 magnification. The patency of the anastomosed vessels was confirmed by Doppler flowmeter. The postoperative following-up periods ranged from 1 to 73 months with a mean of 16.5 months, and the survival rate was 66.2% at 1 year and 42.6% after 3 years.(ABSTRACT TRUNCATED AT 250 WORDS)
Urayama
H
H
Department of Surgery (I), School of Medicine, Kanazawa University, Japan.
Ohmura
K
K
Watanabe
Y
Y
Iwa
T
T
D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical / Q000379:methods; D004938:Esophageal Neoplasms / Q000098:blood supply / Q000401:mortality / Q000601:surgery*; D004944:Esophagoplasty / Q000379:methods*; D004947:Esophagus / Q000098:blood supply*; D005260:Female; D006801:Humans; D007583:Jejunum / Q000601:surgery; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D010614:Pharynx / Q000601:surgery; D015996:Survival Rate; D014654:Vascular Patency